Monitoring of Perioperative Dilutional Coagulopathy Using the ROTEM® Analyzer: Basic Principles and Clinical Examples

Abstract

Recent changes in quality of transfusion supply, transfusion triggers as well as fluid therapy promote the development of dilutional coagulopathy. Nevertheless, up to now guidelines generally assume presence of hypocoagulability when more than one individual circulating blood volume is lost. This might be true for some patients under some conditions but is not necessarily true for every patient. Routine coagulation tests are insufficient in predicting increased bleeding and, moreover, only available after an unacceptable time delay. Therefore, the occurrence of diffuse microvascular bleeding is often used as clinical sign to start hemostatic therapy. However, such severe derangement of hemostasis might lead to the development of secondary tissue damage and frequently is unresponsive to conventional treatment. Coagulopathy occurring during extensive surgery or after polytrauma can be detected and treated early when using the ROTEM monitoring. Recent data showing a direct beneficial effect of hemostatic therapy on blood loss and final outcome are scarce. However, evidence exists that the amount of blood loss, the presence of coagulopathy, and the number of transfusions needed are associated with poor outcome in bleeding patients. Although manifold articles have been published already using thrombelastography for various indications (MEDLINE research ‘thrombelastography’, 2,022 articles), further data are needed to confirm the clinical experience that this technique is an excellent tool for safe patient management.

Multi-centre investigation on reference ranges for ROTEM thromboelastometry

“…Clinical experience with the ROTEM TEM so far shows generally a good separation of values in patients with normal haemostasis and patients with perioperative bleeding disorders [29][30][31][32][33][34].…”

Reference intervals for thromboelastometry with the ROTEM® delta in cats

“…ROTEM/TEG has gained wide use in the human clinical medicine settings including point-of-care test of whole blood for perioperative haemostatic monitoring, optimisation of bloodproduct selection and usage (e.g., cardiac surgery, liver transplantation) (Cammerer et al, 2003;Innerhofer et al, 2004;Kang et al, 1985;Luddington, 2005;Roullet et al, 2010), and monitoring of anticoagulant therapy (Coppell et al, 2006;Lee et al, 1980;Zmuda et al, 2000). During the last years, TEM/TEG also achieved increasing acceptance and application as a diagnostic test in the veterinary medicine (Donahue and Otto, 2005;Kol and Borjesson, 2010;Luddington, 2005;McMichael and Smith, 2011).…”

In vitro thromboelastometric evaluation of the efficacy of frozen platelet transfusion

“…Rotation thromboelastometry (Tem International GmbH, Germany) is based on the original TEG system described by Hartert [19], capable of providing a rapid evaluation of clot formation, strength and lysis, using whole blood. The working principles of ROTEM monitoring and the interpretation of results have been extensively reviewed elsewhere [20][21][22]. Thromboelastometry trace and parameters are shown in Fig.…”